Discussion 5 Respond

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your responses must be substantive and not just agreeing with someone’s work. You need to add by explaining more, refuting a point or correcting a point.  a minimum of 150 words and one reference with in text citation, one reference for each respond.

Discussion 1 George

Describe the presenting problems

Vee is a 26-year-old African-American woman presenting with various symptoms of a psychiatric disorder. She has a history of non-suicidal self-injury that include cutting her arms and legs. Her actions indicate she has anger issues and impulsivity observed through buying lavish gifts for her partner. Vee reports issues with concentration whereby she zones out in the middle of conversations and while at work. She has emotional dysregulation characterized by feelings of doing harm and regretting immediately. Other issues observed in the patient include risky behaviors like multiple sexual partners and suicidal thoughts.

Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.

According to the presenting symptoms, Vee has a borderline personality disorder. The DSM-5 describes borderline personality disorder (DSM-5 301.83 (F60.3) as a pattern of instability in interpersonal relationships, self-image, and affect (American Psychiatric Association, 2013). Patients with this disorder present with an intense fear of abandonment even when the patient is expecting separation. Affected individuals often exhibit changes in relationships and they will either strongly love or hate partners. Another common feature is a strong sense of emptiness that translate to self-harm behaviors like cutting, picking, burning, or suicidal ideations. Impulsivity is a feature of borderline personality disorder that sees patients do self-damaging acts like reckless driving, unsafe sex, unwise spending, or substance abuse (American Psychiatric Association, 2013). Vee presents with anger issues, impulsivity, disturbed self-image, intense fear of abandonment, self-harm, and suicidal ideations that are consistent with those with a borderline personality disorder.

Differential diagnosis is important for distinguishing borderline personality disorder from other mental illnesses like bipolar spectrum disorders. The first differential diagnosis is bipolar disorder because it is characterized by changes in mood leading to outcomes like frustration, separation, and anger. However, mood changes in borderline personality are short-lived and the oscillation is frequent (Perrotta, 2020). Post-traumatic stress disorder is another differential whereby the signs of anxiety, fear, and anger are prominent. This diagnosis is different from borderline because events leading to the signs are evident and often recent (Perrotta, 2020). Other differentials may include schizophrenia, somatoform disorder, and narcissistic personality disorder.

Discuss which cluster the primary diagnosis belongs to

Borderline personality disorder belongs to Cluster B of the ten personality disorders. It is often referred to as the dramatic, emotional, and erratic cluster (American Psychiatric Association, 2013). Cluster B also comprises disorders like antisocial personality disorder, narcissistic personality disorder, and histrionic personality disorder. The key features of diseases from this cluster are problems with impulse control and emotional deregulation.

Formulate and prioritize a treatment plan.

Although personality disorders are considered to be the most difficult to manage, the use of psychotropic drugs and psychotherapy can best serve to improve the patient’s condition. The primary goal of treatment is to reduce intense emotional reactions, improve impulse control and minimize or control self-injurious behaviors. Regarding pharmacological treatment, I will prescribe olanzapine 5mg orally once daily and consider increasing the dosage to 10mg after two weeks. Olanzapine is a second-generation antipsychotic drug whose efficacy for managing traits like impulsivity, aggression, anxiety, and psychotic symptoms are well-known (Gartlehner et al., 2021). The second step will involve referral to a psychotherapist for dialectical behavior therapy (DBT). This approach is supported by literature to be the most effective in managing emotional dysregulation and reduced impulse control (Reddy & Vijay, 2017). DBT uses a series of strategies and involves patients in a training aimed at increasing self-awareness and change.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Gartlehner, G., Crotty, K., Kennedy, S., Edlund, M. J., Ali, R., Siddiqui, M., … & Viswanathan, M. (2021). Pharmacological treatments for borderline personality disorder: A systematic review and meta-analysis. CNS Drugs, 35(10), 1053-1067. /orders/doi.org/10.1007/s40263-021-00855-4

Discussion 2 Rafael

The patient (Vee), a 26-year-old African American woman, presents various mental health symptoms. These issues include non-suicidal self-injury attempts, chronic suicidal ideation, reckless sexual activity with strangers, unwarranted spending, extreme mood shifts, inappropriate anger, chronic boredom, and impulsiveness. Her repetitive suicidal behavior ranges from self-mutilation on her legs and arms since her teenage years to an attempted suicide on two occasions, one as a teenager and the most recent being six months ago. Vee describes that she is sometimes impulsive and will occasionally buy her partner lavish gifts and act in a caring manner towards him. However, she sometimes lashes out and will express inappropriate anger towards him. This is followed by regretful feelings and panic at the thought that he could leave her. Vee also reports having extreme mood shifts, which she describes as a pattern of constant changes in her clothing style, hobbies, social group, and jobs. Lastly, she reports feelings of chronic boredom, which are portrayed as the constant zoning out while working or during conversations.

Based on the presenting problems, the primary diagnosis is that Vee suffers from Borderline Personality Disorder. The DSM5 describes this disorder as a complicated pattern of unstable interpersonal relationships, moods, and a sense of self marked with a heightened sense of impulsiveness. To diagnose this disorder, the patient should manifest at least two personality impairments in self-directionality, intimacy, empathy, and identity (Perrotta, 2020). Similarly, they should exhibit at least four pathological personality traits. These may include hostility, impulsiveness, reckless behavior, disinhibition, depressive behavior, separation anxiety, intense panic and nervousness, and emotional liability. Based on ICD 10, an individual exhibiting this disorder usually portrays impulsiveness, an unpredictable mood, frequent mood shifts, and constant conflict with others when criticized or repressed (Perrotta, 2020).

The differential diagnosis for the presenting issues is that Vee could have bipolar disorder. First and foremost, bipolar disorder is often characterized by constant mood shifts ranging from mania to depression which is also a characteristic of borderline personality disorder. Secondly, bipolar disorder patients exhibit intense feelings of guilt and worthlessness, and one will often zone out or get distracted easily. Thirdly, bipolar patients suffer from recurrent suicidal thoughts and suicide attempts (Bayes et al., 2019). Lastly, bipolar patients exhibit impulsivity, resulting in reckless sexual activity and unwarranted spending.

The presenting symptoms in this case study reveal that the patient likely has a borderline personality disorder, our primary disorder. Based on the DSM5, this disorder is classified as a cluster B personality disorder (Perrotta, 2020). Typically, patients exhibit impulsivity, emotional dramatization, and unpredictable behavior in this cluster. Usually, this cluster includes disorders that portray erratic and dramatic behaviors (Stern, 2016). With borderline personality disorder, patients exhibit a recurring fear of abandonment which could be imagined or real. Secondly, patients often display self-mutilating behavior and repetitive suicidal behavior. Thirdly, patients exhibit self-damaging behavior portrayed by a heightened sense of impulsiveness in the form of unnecessary spending, reckless sexual activity, binge eating, and substance abuse. Fourthly, patients display inappropriate anger and recurring outbursts (Perrotta, 2020). At times patients may suffer from chronic boredom and intense feelings of emptiness. Further, they may experience identity problems and dramatic changes in personal values, goals, and interests.

As described in the case study, the patient exhibits cluster B symptoms of borderline personality disorder. To treat this disorder, Vee should undergo Dialectical behavioral therapy, which is one of the most effective treatment methods for this disorder. Usually, this treatment undertakes a collaborative systems approach by incorporating all aspects of the patient’s behaviors (Perrotta, 2020). The therapy teaches the patient coping skills since it recognizes that the negative behaviors associated with this order are learned. Further, this therapy helps the patient to learn how to recognize negative behaviors and feelings beforehand so that one can deal with them outright. In essence, this treatment approach applies empathy and understanding to teach its patients coping skills (Perrotta, 2020). Over time, with this therapy, Vee can learn to cope with situations better and reduce her reliance on unsafe and self-injury behavior.

References

1- Bayes, A., Parker, G., & Paris, J. (2019). Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder. Current Psychiatry Reports, 1-11. /orders/doi.org/10.1007/s11920-019-1120-2